Cervical incompetence: diagnostic and therapeutic aspects

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Cervical incompetence is a significant cause of pregnancy loss.
• Cerclage is a surgical procedure to prevent premature cervical dilation.

Purpose of the Study:

• To evaluate the effectiveness of cervical cerclage in improving fetal salvage rates.
• To identify prognostic factors and optimize the cerclage procedure.

Main Methods:

• A retrospective study of 391 pregnancies in 311 women with cervical incompetence treated with cerclage over seven years.
• Elective cerclage candidates selected based on hysterography and Hegar test.
• McDonald procedure performed typically at 11-12 weeks gestation after ultrasonic confirmation of fetal heartbeat.
• Analysis of fetal salvage rates and prognostic value of Hegar test.

Main Results:

• Overall fetal salvage rate was 89%.
• Ultrasonic detection of fetal heartbeat before cerclage significantly improved fetal salvage.
• Hegar test findings indicated prognostic value for cerclage-treated pregnancies.
• Hospitalization post-cerclage was reduced to under 24 hours.

Conclusions:

• Cervical cerclage is an effective intervention for cervical incompetence, substantially improving fetal salvage.
• Pre-cerclage ultrasound confirmation of fetal heartbeat is crucial for reducing early fetal loss.
• Simplification of the surgical procedure is recommended for improved outcomes.